Black Death: AIDS in Africa, and: Waiting to Happen: HIV/AIDS in South Africa: The Bigger Picture (review)

In December 2003, the Joint UN Program on HIV/AIDS estimated that roughly twenty-six million people in sub-Saharan Africa are HIV positive. AIDS already has led to a decline in life expectancy in several southern African countries. It threatens to stifle economic growth, create millions of orphans, and reshape African communities, because the disease disproportionately kills the young, productive members of society. Two recently published books, Black Death: AIDS in Africa and Waiting to Happen: HIV/AIDS in South Africa, seek to contextualize the AIDS crisis by examining the cultural, social, historical, and biological variables that have contributed to the spread of HIV and have shaped responses to the disease.

Black Death has an ambitious agenda: "This book is more comprehensive than the typical AIDS book because it is premised on the idea that we have to widen our focus from the relatively narrow fields of science and medicine to look at the epidemic's social, political, and historical antecedents if we are to find a ‘cure' for AIDS" (9). The desire to move beyond a narrow scientific study of AIDS is not unique, as evidenced by the recent publication of AIDS in the Twenty-First Century: Disease and Globalisation (2002), HIV and AIDS in Africa: Beyond Epidemiology (2004), and The Political Economy of AIDS in Africa (2004).¹ The first three chapters of Black Death concentrate on socioeconomic and historical factors. The book investigates how the slave trade, colonialism, labor exploitation, and the Cold War have profoundly shaped the health of Africans. The historical overview is rich in detail, particularly about the negative effect of Africans' forced conscription into colonial armies on the health and well-being of all Africans.

In chapters 4, 5, and 6, Black Death examines the social history of other epidemics, such as leprosy, plague, and syphilis. These well-written chapters urge the reader to contrast individual, social, and policy responses to past epidemics with reactions to AIDS. At times, though, the reader may wish that the comparisons with AIDS were made more explicit. For example, the infertility that accompanied the spread of syphilis among African women during the colonial period created economic problems, social disorder, and personal despair. Since HIV also decreases fertility, how might African women and, more broadly, African society be affected? Can parallels be drawn with the continent's past experience with syphilis?

Despite Hunter's claim to move beyond scientific approaches to AIDS, chapter 7 of Black Death uses Darwin's evolutionary theory to examine the interrelationship between sex, disease, and species survival. Humans and diseases are in a coevolutionary process: HIV develops mutant strands in response to antiretroviral therapy (ART), but sexually transmitted diseases such as AIDS may play the evolutionary role of "reducing the reproductive potential of individuals in human populations with high hormone levels whose genes might otherwise dominate the group" (201). For those not trained in the sciences, the chapter provides fascinating examples of humans developing genetic traits to protect against microbes, such as the S genetic allele that reduces malaria's impact on its carrier, or the gene that protects against the bacterium causing typhoid fever. (In both cases, however, when children inherit two copies of the "protective" gene, they develop serious medical conditions: sickle cell anemia, in the first case, and cystic fibrosis, in the second.) Hunter maintains that in this coevolutionary relationship, "microbes have the advantage" (198). To successfully adapt, humans must better understand "the impact of our actions on the intimate world of disease-causing agents and their vectors" (198).

In its...